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Review
. 2025 Mar 10;12(1):e70173.
doi: 10.1002/jeo2.70173. eCollection 2025 Jan.

Surgical treatment of acute high-grade acromioclavicular joint dislocations

Theodorakys Marín Fermín  1   2 , Chih-Kai Hong  3 , Lucca Lacheta  4 , Lukas N Münch  4 , Knut Beitzel  5 , Eoghan T Hurley  6   7 , Kai-Lan Hsu  3 , Emmanouil Brilakis  8 , Berte Bøe  9 , Davide Cucchi  10
Affiliations
Review

Surgical treatment of acute high-grade acromioclavicular joint dislocations

Theodorakys Marín Fermín et al. J Exp Orthop. .

Abstract

Treatment options for acute acromioclavicular joint (ACJ) instability include several surgical and non-surgical approaches. Recent trends indicate a shift towards nonoperative treatment, even for severe Rockwood type V injuries, which traditionally required surgery. Despite this shift, some patients may still benefit from surgical stabilisation, particularly if significant pain and disability persist. Modern surgical techniques focus on cortical button systems and restoration of the coracoclavicular ligaments, emphasising the importance of the posterosuperior acromioclavicular capsuloligamentous complex in managing horizontal instability. Clavicular hook plates offer rigid stability but present risks, such as damage to the subacromial structures and acromial erosion. Although anatomical repair techniques have gained prominence due to their biomechanical advantages and have been endorsed by international societies, non-anatomic methods may also provide acceptable outcomes with lower costs. The use of tendon grafts in chronic ACJ instability has shown promise, although evidence for their use in acute cases remains limited. This review discusses various treatment strategies, including operative and nonoperative management, focusing on patient outcomes, complication rates, and return-to-sport scenarios. Ultimately, the choice between surgical and non-surgical treatment must consider individual patient needs and the potential for long-term recovery. Level of Evidence: Not applicable.

Keywords: acromioclavicular; coracoclavicular; dislocation; shoulder; sports injury.

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Conflict of interest statement

The authors declare no conflicts of interest relevant to the content of this review.

Figures

Figure 1
Figure 1
A 34‐year‐old man presented with a Type V acromioclavicular (AC) dislocation. The preoperative (a) and postoperative (b) plain films are shown. The surgical procedure was performed with the patient in the beach‐chair position. An incision was made directly over the AC joint. The AC ligament was found to be avulsed from the acromion (arrow) (c). The AC repair involved placing three transosseous sutures between the superior part of the acromion and the posterosuperior part of the distal clavicle (d). For coracoclavicular (CC) augmentation, one Mersilene tape and two No. 5 Ethibond sutures were used (e). The sutures for both the AC and CC repairs were initially left untied. A clavicular hook plate was then applied over the sutures, ensuring that the sutures were not visible in the screw holes (f). Once all the screws were secured, the sutures for the AC repair and CC augmentation were tied (g).
Figure 2
Figure 2
(a) Schematic representation of the suture‐based acromioclavicular joint repair. (b) Preoperative anteroposterior (AP) radiograph of a patient with an acute Rockwood V acromioclavicular joint (ACJ) right shoulder injury. (c) An immediate postoperative AP radiograph showed an overreduction of the ACJ. (d) 1‐year postoperative follow‐up AP radiograph.
Figure 3
Figure 3
(a) Preoperative radiograph of a patient with an acute Rockwood V acromioclavicular joint (ACJ) left shoulder injury. (b) Arthroscopically assisted anatomic acromioclavicular and coracoclavicular stabilisation postoperative radiograph.
See this image and copyright information in PMC

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